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亚急性和慢性腰痛的非手术介入治疗

Author
Roger Chou, MD
Section Editors
Steven J Atlas, MD, MPH
Ellen WK Rosenquist, MD
Deputy Editors
Lee Park, MD, MPH
Marianna Crowley, MD
Translators
翁莹琪, 主治医师

引言

多达84%的成年人在一生中的某些时间会发生腰痛[1,2]。腰痛的长期结局一般较好[3]，但是由于其很常见，持续性症状影响着数百万人。亚急性腰痛通常是指持续4-12周的腰痛，如果腰痛持续12周或更长时间，则被称为慢性腰痛。

在初级保健机构就诊的大多数患者(>85%)存在“非特异性腰痛”，非特异性腰痛是指不能确切归因于某种特定疾病或脊柱病变的腰痛[4]。在第1个月内，通常患者的疼痛和失能会迅速改善，并恢复工作[5]。在3个月期间情况通常会进一步改善，此后患者的疼痛、失能水平和恢复工作率相对恒定。背痛致失能人群中约5%的患者，其花费的腰痛相关支出占总数的75%[6]。

亚急性和慢性腰痛有多种治疗方法，大体上可分为药物和非介入治疗、非手术介入治疗和手术治疗(表 1和表 2和表 3和表 4)。本专题将阐述接受保守治疗失败的亚急性、慢性腰痛患者的非手术介入治疗。其中一些非手术介入治疗方法是向脊椎结构内注射药物(通常为糖皮质激素)。而另一些方法则是通过使用各种能量，来破坏推定为疼痛来源的背部组织。

总体上讲，不认为亚急性非特异性腰痛患者适合接受介入治疗，因为通过无创治疗，此类患者仍可能改善，并且关于在这种情况下使用有创治疗效果的证据极少[7]。对于亚急性和慢性神经根病或者严重致残性慢性非特异性腰痛患者，难以绝对性地给出应在何时考虑进行非手术介入治疗的建议。对于对无创治疗无效，并且不愿意接受手术治疗或者不适合接受手术治疗的患者，考虑进行一些非手术介入治疗是合理的。专门评估椎管狭窄患者的随机试验相对较少[8,9]，不过，有许多试验评估了多种人群。

急性腰痛的治疗将单独讨论(参见“急性腰痛的治疗”)。亚急性和慢性腰痛的保守性非介入治疗、手术选择和结局将单独讨论。 (参见“亚急性腰痛和慢性腰痛的药物和非介入治疗”和“亚急性和慢性腰痛的手术治疗”)

                     

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Literature review current through: 2017-06 . | This topic last updated: 2017-06-21.
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